A new Federal study on pregnancy-related deaths among specific racial and ethnic groups in the United States found that Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women had a significantly higher risk of death related to pregnancy than non-Hispanic white women.
"Pregnancy-Related Death Among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native Women, United States, 1991-1997" appears in the May 11, 2001, issue of the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC).
Between 1991 and 1997, there were 3,193 pregnancy-related deaths – that is, deaths due to pregnancy that occurred to women during their pregnancy or within a year after the end of pregnancy. This translated into an overall ratio of 11.5 pregnancy-related deaths per 100,000 live births. (This is often referred to as the pregnancy-related mortality ratio, or PRMR.)
During the study period, the PRMR for Hispanic women was 10.3; for Asian/Pacific Islanders, 11.3; and for American Indians/Alaska Natives, 12.2. These ratios are much higher than for white women in the same age range, with a PRMR of 7.3. However, black women had the highest death rate, with an overall PRMR of 29.6.
"Despite advances in public health and obstetrics over the past century, not all women have a safe and healthy pregnancy,"said CDC Director Dr. Jeffrey Koplan. "This report, which delineates disparities in pregnancy-related deaths among women in specific racial and ethnic groups, helps expand our understanding of why death rates differ and what we can do to prevent them."
Among all race and ethnic groups, the risk of death due to pregnancy was lowest among women under 30 and rose after age 35.
The CDC analysis also found additional factors to be as important as racial/ethnic status for some groups. For example, Hispanic women who were born outside the 50 states and the District of Columbia and later immigrated to this country had PRMRs almost 50 percent higher than Hispanic women born in the United States. There may be a similar trend for Asian/Pacific Islander women, but the numbers were too small to be certain. Place of birth had no effect on the PRMR for white and black women, and the numbers for American Indian/Alaska Native were too small to analyze.
Previous studies have identified black-white disparities, but have combined the remaining racial/ethnic groups as "other," thus masking differences in health status, according to the CDC report.
"Attention to race and ethnicity may hide the effects of other risk factors such as poverty," said the study author, Dr. Sara Whitehead, a reproductive health epidemiologist at CDC. "We need to expand this type of public health monitoring to determine why some women are at higher risk of pregnancy-related death. We need to examine issues such as access to care, quality of care, health insurance status, language and cultural barriers to care, immigration issues, and socioeconomic status."
Pregnancy-related death is rare today, but it still occurs. Moreover, pregnancy-related complications, such as ectopic pregnancy, severe bleeding, and infection, still affect 2,000 women each day.
"Childbirth often was a life-threatening event just a century ago," said Dr. Lynne Wilcox, director of CDC's reproductive health program. The average lifespan for an American woman at the turn of the 20th century was only 48 years.
"We are convening a National Summit on Safe Motherhood in September to explore these current issues and identify prevention strategies," said Dr. Wilcox. The summit will bring together researchers, clinicians, program experts, policymakers, and advocates to address a range of issues related to pregnancy, childbirth, and overall reproductive health.
Data in this report come from CDC's National Pregnancy-Related Mortality Surveillance System. For more information on safe motherhood and reproductive health go to: http://www.cdc.gov/nccdphp/drh.
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